Services We Do and Do Not Provide

Disruptive Behavior Intensive Outpatient Program

What is the Intensive Outpatient Program for Disruptive Behavior?

The Disruptive Behavior Intensive Outpatient Program provides evidence-based treatment for caregivers of children who struggle with unsafe behaviors, including aggression and property destruction. Our program lasts  7 weeks and offers group sessions 3 hours per day, 3 times a week, in addition to two 1-hour individualized sessions to help caregivers build skills to prevent and respond to behavioral escalations in the family through the following:

  • Caregiver skills group meetings focused on de-escalation and behavior management strategies
  • Caregiver-child sessions focused on practicing plans and strategies
  • Caregiver wellness group meetings with peer partners who have experienced living with a child in crisis
  • Individualized caregiver sessions with a therapist and peer partner to further process program-related topics
  • Case management sessions to help families connect to community resources
  • Psychiatric medicine consultations and school consultations as needed

Who can this program help?

Our Disruptive Behavior Intensive Outpatient Program is only intended for caregivers covered by Apple Health (Medicaid) at this time who have a child between the ages of 5 and 12 years old who either:

  • Is in a persistent state of externalizing behavioral crises such as aggression to self or others, property destruction, leaving the house without permission when they are aware they’re not supposed to and verbal threats to harm self or others
  • Has been in an inpatient psychiatric unit and needs treatment more intensive than routine outpatient and/or is at risk of being hospitalized again
  • Presents with severe symptoms that place them at risk for an inpatient psychiatric hospitalization or psychiatric residential treatment
  • Has been in outpatient services that have not been successful in resolving unsafe behaviors

What’s special about the Seattle Children’s Disruptive Behavior Intensive Outpatient Program?

Our Disruptive Behavior Intensive Outpatient Program team will work closely with you and your family using this approach: 

  • The Disruptive Behavior Intensive Outpatient Program is based in parent behavior management training (PBMT). Research shows that PBMT is very helpful in improving child behavior and improving family functioning.

  • The Disruptive Behavior Intensive Outpatient Program delivers care through a team approach as opposed to individualized care. Our Intensive Outpatient Program team works closely with your family to include you in every step of the process and provide a supportive environment.

  • The Disruptive Behavior Intensive Outpatient Program team not only includes professionals who are experienced in working with children and youth with Disruptive Behavior but also includes peer partners. Our peer partners have experience living with a child in crisis and are available to support your family throughout the duration of the Disruptive Behavior Intensive Outpatient Program. 

Who is on the team?

Providers in this program include: 

You may also work with a psychiatric nurse practitioner and psychiatry or psychology trainees.

How to Get Services

We accept referrals from the following Seattle Children’s Hospital service lines: Psychiatry and Behavioral Medicine Unit, Emergency Department and Acute Behavior Crisis Clinic. We also accept referrals from outside Seattle Children’s, including outside emergency departments, primary care providers and mental health therapists.

If you are interested in the Disruptive Behavior Intensive Outpatient Program, contact your child’s provider to place a referral.

  • They will send us a referral and screening information to see if the program is appropriate for your family.
  • Once the referral is screened and determined to be appropriate, you will be placed on a wait list.
  • When enrollment opens, we will contact you to schedule an intake. The intake is scheduled for 60 minutes over Zoom and will allow our team to determine if your family meets the medical necessity for the Disruptive Behavior Intensive Outpatient Program.
  • If your child’s needs can be met in a less intensive program or if they need a higher level of care, we will recommend other options.
  • If your provider has questions about the Disruptive Behavior Intensive Outpatient Program, they can email us at db.iop@seattlechildrens.org.

What to Expect

The Disruptive Behavior Intensive Outpatient Program delivers all services using telemedicine.

    • Plan ahead to ensure that you can attend sessions with a distraction-free environment. You should not be driving a car, riding a bike or cooking during sessions.
    • Plan for childcare or an activity for your child during the sessions. It is important to note that your child will only be involved for limited caregiver-child sessions. Your child will not be involved in any of the caregiver wellness or caregiver skills groups.
    • You will need to connect to sessions with both audio and video and have your camera turned on during the entire session. Please ensure that your audio and video are both working. If you have any questions about telemedicine, contact the Disruptive Behavior Intensive Outpatient Program case manager or check out Telemedicine at Seattle Children’s.
    • The Disruptive Behavior Intensive Outpatient Program team will mail out a workbook to you a week before your program start date. Please bring this workbook and a pen or pencil with you to sessions.
    • Treatment is offered through telemedicine/video visit platforms.
    • The program is intense and requires a great deal of dedication of parent and/or caregiver time. It runs 3 hours per day, 3 days per week, and lasts 7 week
    • Times will be:
      • Monday 9:30 a.m. to 12:30 p.m.
      • Wednesday 2 to 5 p.m.
      • Thursday 9:30 a.m. to 12:30 p.m.
      • Individualized sessions: Scheduled for 1 hour on Monday and Thursday afternoons
    • Additionally, case management will be provided as needed during the program.
    • Initial phone screening
      • Time: One 10-minute appointment.
      • What: The initial phone screening occurs when the Disruptive Behavior Intensive Outpatient Program case manager contacts the primary caregiver directly after receiving the referral from one of the approved Seattle Children’s service lines. The Disruptive Behavior Intensive Outpatient Program case manager will ask any follow-up questions needed to determine if the Disruptive Behavior Intensive Outpatient Program will be a good fit for the family and schedule the intake session. 
    • Intake session
      • Time: One 60-minute appointment.
      • What: During the intake session, the primary caregiver will meet with the Disruptive Behavior Intensive Outpatient Program case manager and clinician to assess whether the child meets the medical necessity for the program and if the family is able to commit to the program. Additionally, the clinician will provide an in-depth overview of the program and program requirements and answer any questions that the caregiver may have.
    • Caregiver wellness groups
      • Time: One 60-minute session and one 90-minute session.
      • What: During the caregiver wellness groups, peer partners will collaborate and provide support in a nonjudgmental space, giving caregivers an opportunity to share their struggles and successes with other caregivers.
    • Caregiver skills group
      • Time: Three 90-minute sessions a week.
      • What: During the caregiver skills groups, the clinicians will provide in-depth instruction on de-escalation and behavior management strategies for caregivers.
    • Caregiver-child sessions
      • Time: One 90-minute session a week.
      • What: During the caregiver-child sessions, the clinicians will support the caregivers in smaller groups. Your child will be involved for approximately 15 minutes of the session. The goal is to practice the strategies learned during the caregiver skills groups.
    • The Disruptive Behavior Intensive Outpatient Program requires that the primary caregiver be present for every appointment. Additionally, we welcome and strongly encourage other caregivers and family support to attend the appointments if they are available.
    • During the program, we will help you find your next treatment team and make appropriate referrals for continued care. We are unable to provide long-term follow-up treatment for families after the program ends.
    • Each session has planned content that is important to learn. If you miss more than 3 sessions or visits, the Disruptive Behavior Intensive Outpatient Program team will meet with you to discuss if the program remains a good fit. If attendance remains a concern, you will be politely removed from the remainder of the program.
    • If you need to cancel or plan to miss a session, please email the Disruptive Behavior Intensive Outpatient Program case manager as soon as possible.
    • Due to the structure of our program, we are unable to reschedule group sessions. Individualized sessions can be rescheduled within the same week depending on provider availability.
    • If you are more than 15 minutes late for more than 3 sessions, the Disruptive Behavior Intensive Outpatient Program team will meet with you to discuss if the program remains a good fit for your family.
    • Any no-shows will prompt an immediate discussion with the Disruptive Behavior Intensive Outpatient Program team to determine if the program remains a good fit for your family.

Contact Us

For patients and families not enrolled in the Disruptive Behavior Intensive Outpatient Program but are interested or have questions, please have your provider or case manager reach out to db.iop@seattlechildrens.org. Please note, we cannot provide updates on wait list time. When a slot becomes available, the Disruptive Behavior Intensive Outpatient Program case manager will contact you.

For patients and families enrolled in the Disruptive Behavior Intensive Outpatient Program and have questions, email the Disruptive Behavior Intensive Outpatient Program at db.iop@seattlechildrens.org.

Paying for Care

This program is only available for families covered by Apple Health (Medicaid) at this time through pilot project funding from Washington State Health Care Authority. There is no cost to eligible families.

In a Crisis?

If your child or family needs help right away, call your mental health crisis line or text HOME to 741741.

If you or a family member has a problem with a substance use disorder, please consider calling SAMHSA’s National Helpline, 800-662-4357.